Little Red Health Check

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Please fill out the following form:

Last Name *

First Name *

Have you experienced any of the following symptoms in the last 24 hours? * *

Fever or Chills

Body/Muscle Aches

Persistent Coughing

Shortness of Breath or Difficulty Breathing

New Loss of Taste or Smell

Sore Throat

Nausea, Vomiting, or Diarrhea

Congestion or Runny Nose

I haven't experienced any of these symptoms in the last 24 hours.

Required

In the last 14 days, have you been in contact with someone who has tested positive for COVID-19? * *

Yes

If you have been in contact with someone who has tested positive for COVID-19 or if you are experiencing ANY of the symptoms listed above, please stop and go home. By checking the box below, I attest to the fact that these questions have been answered truthfully and to the best of my ability. * *

I understand health and safety policy and certify that I am symptom free and in good health.

Required

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